29 research outputs found

    Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

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    Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

    Efficacy of Co-synch Protocol on Normal Cyclic Dairy Cows with or Without Corpora Lutea

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    Improving reproductive efficiency, estrus synchronization and controlled breeding protocols are efficient management techniques in dairy cows. Therefore, the present study was designed to compare the efficacy of Co-synch protocol in the cows carrying corpora lutea (CL), without CL or with unexamined ovarian structure. Fifty-six cows were divided into 4 groups; control group1 (n=12) and Co-synch treated groups; group2: cows with unexamined ovarian structure group (n=9), group3: cows having only follicles without mature Cl (n=16) and group4: cows having mature Cl (n=19). Ultrasonography was performed before and after gonadotropin (GnRH) injection. Blood was collected for analysis of progesterone (P4) and estradiol 17-ß. Reproductive data was obtained regarding 1st service conception rate (1st SCR), number of services/conception (s/c) and days open. Ultrasonography revealed luteinization in cows without mature CL. While those having mature CL showed increase in the size of the CL or formation of accessory CL. Results revealed significant decrease in serum P4 before GnRH treatment in cows having no mature CL. Significant increase in serum P4 levels in all groups was recorded after GnRH treatment. Besides, the highest P4 level was assessed in cows having mature CL. Estradiol 17-ß was significantly decreased in cows having mature CL before and after treatment. Cows having mature CL revealed significant upgrade in the percentage of 1st SCR, decrease in s/c and shortening in days open as compared with other groups. In conclusion, applying Co-synch to the cows carrying CL is beneficial and promises protocol to improve reproductive performance in dairy cows
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